Micro quiz 4th yr

Nano Quiz(t)For medical student

Sathienwit Rowsathien, MD, Flg. Off.Internal Medicine Resident

Chiang Mai University

Describe these lesion and Diagnosis…

Cutaneous telangiectasia

AVM of the left hemisphere (Brain)

AVM of the left lung (Pulmonary)

Mucosal telangiectasia

Hereditary hemorrhagic telangiectasia

• Eponym: Osler–Weber–Rendu disease

• Autosomal dominant ENG, ACVRL1 and MADH4 mutations

• Abnormal blood vessel formation in the• Skin, Mucous membranes and end organs such as Lungs, Liver and Brain.

• Curaçao criteria (3/4)• Spontaneous recurrent epistaxis• Multiple telangiectasias in typical locations• Proven visceral AVM (lung, liver, brain, spine)• First-degree family member with HHT

• Only symptomatic treatment

William Osler, Frederick Parkes Weber and Henri Jules Louis Marie Rendu

Describe these lesion and Diagnosis…

Splinter hemorrhage

Roth’s spot

Osler node

Janeway lesion

Infective endocarditis

• Modified Duke’s criteria (2 majors, 1+2 or 5 minors)• Major

• Sustained Bacteremia (viridans streptococci,Staphylococcus aureus, Streptococcus bovis, HACEK group or only +ve Coxiella)

• Evidence of Endocardial involvement (TTE see Vegetation, New valvular regurgitation)

• Minor • Predisposing heart condition, Fever >= 38.0 C, Vascular phenomena, Immunologic

phenomena, Positive blood culture not meeting major

• Acute (high Virulence S.Aureus), subacute (less S.Viridans)• EKG: new conduction abnormalities• NVE: Acute Vanco, subacute Cef-3• PVE: Early < 60days Vanco+Cefepime+Genta, subacute Vanco+Genta• Endocarditis prophylaxis (PV, previous NVE, transplant, CHD) before Dental&Respiratory procedure

• Amoxycillin 2 g, Cef-3 1 gm IM or Clinda 600 mg 30 min before.

Describe these lesion and Diagnosis…

NecrobiosisLipoidicaDiabeticorum

AcanthosisNigricans

KimmelstielWilson FSGH

Foot (Pressure area)Ulceration

Diabetes Mellitus

• FBS >=126,HbA1C > 6.5 or Random >= 200 mg/dl *2 occasions• 1 if severe + symptomatic (DKA, HHS)

• Type 1, 2, MODY, 2nd causes (Gestational, drugs (PI, Psychi), cushing)

• Polyuria, Polydipsia and polyphagia.

• Aware Complication Retinopathy, Nephropathy, Neuropathy, Artherosclerosis, Infections

• Must control comorbid disease (HT keep <140/90, LDL <100)

• Must screening yearly for• Dilated Retinal exam yearly by ophthalmologist• Microalbuminuria (spot) goal <30• Diabetic neuropathy (Monofilament)

Describe these lesion and Diagnosis…

Xanthelasma Corneal Arcus

Eruptive Xanthoma

Tendon Xanthoma

Dyslipidemia

• Tendon Xanthoma LDL specific (may >300mg/dl)

• Eruptive Xanthoma (pimple) TG specific (may >1,000 mg/dl)

• Xanthelasma any type of dyslipidemia, Corneal arcus non specific in older adults.

RisksMale> 45, Female>55,smoking, HTN, FHX +ve, HDL<40 (if >60 -1risk)

Describe these and Diagnosis…

S1Q3T3, Sinus tachycardia, RBBB, TWI in V1-V4(5), P pulmonale

Describe these lesions and Diagnosis…

Hampton’s Hump Westermark sign

Pulmonary Embolism

• Dyspnea and pleuritic chest pain, tachypnea

• Hypoxemia with increase A-a gradient

• Simplified Well score

• EKG: most common Sinus tachycardia

• Gold: CTA if high risk, d-dimer if low risk (< 500ng/ml excluded PE)

• Work up for Thrombophilia OCP, HRT and Malignancy

• Enoxaparin 1mg/kg SC BID 5 days long term warfarin INR 2-3

Describe these lesions and Diagnosis…

Discoid rash (Erythematous papule/plaque with keratosis and plugging)

Malar rash

Systemic Lupus Erythematosus

• Serositis, Oral Ulcer,

• Arthritis (non-erosive),

• Photosensitivity rash,

• Blood (leukopenia <4,000, lymphopenia <1,500 or thrombocytopenia <100,000),

• Renal (RBC cast or Protein uria >0.5 gm/day),

• ANA, Immunologic (dsDNA, smith, Anti Phospholipid),

• Neuro (seizure or psychosis),

• Malar, Discoid• 4/11

Revise (2012) SLICC for Research

Systemic Lupus Erythematosus

• Control symptom• Prednisolone low dose (10-15mg)

• HCQ

• NSAIDS

• Lupus Flare/ severe flare• Steroid high dose (1mkd)

• Mycophenolate LN

• IVCY LN, CNS• AZA, MTX, CsA, Rituximab, Belimumab limit used

Describe these lesions and Diagnosis…

Webbed neck 45X

Turner syndrome

• Ullrich–Turner syndrome "Gonadal dysgenesis“• Absence of an entire sex chromosome, the Barr body, sporadic

• Low set ears, Low hairline, Amenorrhea, Webbed neck,

• AS(Bicuspid),Coarctation of aorta,

• Horse shoe kidney,

• Lymphedema, Short stature

• Treatment• GH

• Estrogen replacement therapy

Describe these and Diagnosis…

ST segment elevation V1-V3

Brugada Syndrome

• Nocturnal Death Syndrome

• 3 type of EKG• I. Coved ST segment elevation >2mm in >1 of V1-V3 followed by a negative T wave.

• II. >2mm of saddleback shaped ST elevation.

• III. I or II morphology but <2mm ST elevation

• Treatment: ICD

Describe these lesions and Diagnosis…

Pneumatocele at RLL

Staphylococcal Pneumonia

• May be post viral or HAP/ HCAP

• Consider MRSA Vancomycin

• Prediction of severity• SMARTCOP

• SBP < 90 (2), multilobar, albumin <3.5g/dl, RR >= 30, Tachycardia >125, Confusion, O2sat <90% (2), Arterial pH <7.35(2)

• CURB 65• Confusion, BUN >19 mg/dl, RR > 30, BP< 90/60, Age >=65

• >=3 point need ICU

Describe these lesions and Diagnosis…

Kayser–Fleischer ring

Wilson’s disease

• Mutation in ATP7B copper overload

• Neurologic Wilson’s Parkisonism (hepatolenticular), KF rings

• Diagnosis by• Increase 24 hours urine Cu, decrease of serum Ceruloplasmin

• Treatment• Copper chelation with Penicillamine + B6, Zinc

Describe these lesions and Diagnosis…

Plasmacytoma

RouleauxFormation

Plasma cell

Bony erosion “Punch out”

Multiple Myeloma

• Clinical CRAB• Hypercalcemia

• Renal involvement (Ig light chain, RF or infiltrative)

• Anemia

• Bone pain

• Symptomatic MM criteria (3/3)• M protein in serum/ urin

• Bone marrow clonal plasmacytosis >10% or plasmacytoma

• ROTI lytic bones, Ca >11.5g/dl, Cr >2mg/dl, Hb <10

• Treatment by induction chemo + supportive treatment

Describe these lesions and Diagnosis…

Golden S sign

Lung cancer

• Golden S sign = reverse S sign of Golden• RUL atelectasis

• May be from central mass obstructing the upper lobe bronchus

• Suspicion of a primary bronchogenic carcinoma

• Central lesion Squamous, Small cell

• Peripheral Adenocarcinoma(KRAS), Large cell

• Adenocarcinoma most common in non-smoker!

• Endobronchial growth symptom cough, hemoptysis and dyspnea

• Paraneoplastic ACTH, ADH release, Eaton Lambert SCLC, PTH-rP Squamous, Clubbing finger non-small cell, Hypertrophic osteoarthropathy Adenocarcinoma

Spot parasite Diagnosis

Isospora belli oocyst Hookworm ova Ascaris fertilized ova Capillaria

Cyclospora Cryptosporidium

Intestinal parasitic treatment

• Isospora Self limited, AIDS TMP-SMX

• Hookworm Ivermectin 200ug/kg/day for 3 day, Albendazole (400) 3 days

• Ascaris Albendazole (400) single dose

• CapillariaAlbendazole (400) 10 days

• Cyclospora TMP-SMX DS bid 3 days, AIDS 10 days

• Cryptosporidium Self limited, only supportive, AIDS Atovaquone, Paromomycin???

Good LuckFor tournament and Exam